Acute Care Across the Lifespan B

Running Head: Acute Care Across the Lifespan B
ACUTE CARE ACROSS THE LIFESPAN B

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Acute Care Across the Lifespan B
Table of Contents
1. Introduction............................................................................................................................3
2. Analyzing the changes in clinical representation of Mrs. Kennedy.......................................3
3. Discussing and critically evaluating the priorities of care.....................................................5
4. Discussing the psychosocial issues related to current disease stage of Mrs. Kennedy..........7
5. Conclusion..............................................................................................................................7
Reference list..............................................................................................................................9

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Acute Care Across the Lifespan B
1. Introduction
The purpose of this essay is to discuss the issue that Mrs. Kennedy is facing by using
clinical reasoning cycle and critically analyze the priorities of care. Mrs. Kennedy has
previous history of ischemic heart disease, hypertension, and PVD. Considering the
situation of the patient, it can be said that her condition is deteriorating as her vital signs
like pulse rate, BP, respiratory rate is showing abnormality. Pathophysiological process has
been discussed in this essay, which means mechanism behind the development of a condition.
Setting nursing priorities is essential for providing treatment in a systematic way, which
eliminates any error in practice. Nursing problems are solved by establishing a preferential
order. In this case, the recent health deterioration of Mrs. Kennedy has increased the need for
priority setting to avoid any emergency situation. Moreover, she has undergone CABG and
PTCA that states she has a poor heart condition and need attention immediately.
2. Analyzing the changes in clinical representation of Mrs. Kennedy
Collection of information is an important part of understanding the issue. Before the
pressure sensation felt by the patient on her chest, vital signs have been measured. The
temperature of the body was 37.3°C, pulse rate was 74 bpm, strong volume and regular.
Respiratory rate of this patent was 14/min, regular with normal depth. BP was 165/90, which
is normal for her and the SpO2 was 98% on room air. The changes in vital sign take place
after 30 min, the patient was a little diaphoretic and she has felt a mild pressure sensation in
her chest. At that stage, the temperature was near about the same, but the pulse rate has been
increased to 116bpm, regular. However, the pulse rate was not strong. The respiratory rate
has been slower to 26/min. BP dropped to 105/70 mm-Hq. SpO2 level fallen to 92% on room
air. She has a history of Ischemic Heart Disease (IHD) beginning peripheral vascular disease

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Acute Care Across the Lifespan B
(PVD) and hypertension. Six years ago, she has experienced CABG with saphenous vein
graft to the diagonal branch and left anterior descending (LAD). She underwent PTCA with
stenting to RCA and PDA, 2 years ago.
Processing information is the next step for understanding the issue. Her heart rate
has been increased with the RR. As per the Starling Law, the volume of stroke and the end-
diastolic volume is interrelated (Cvphysiology.com, 2019). Before contraction, when all
factors are constant, an increase of blood volume in the ventricle causes an increase in stroke
volume. In the case of this patient, this mechanism has taken place and as a result, her heart
rate and pulse rate has been increased. Diaphoretic with cool peripherals have been noted.
Identification of the issue can be done after getting the processed information. Increased
heart rate with this symptom refers to a heart attack of this patient. Mild chest pain and a
slight ache in the upper left arm are confirming her heart attack. According to Weinstock et
al. (2015), after 8 to 10 years of CABG, the chances of death have increased by near about
60-80%. Mrs. Kennedy has undergone CABG before 6 long years and at present, her risk of
mortality has increased. In this case, her BP has been dropped. Maybe this situation has
occurred due to pumping of less amount of blood by the heart. As mentioned by Foy, Liu,
Davidson, Sciamanna & Leslie (2015), during a heart attack, BP can be lowered in response
to the pain occur. However, in this case, the pain was mild as the patient has rated her chest
pain 4/10. It means that BP has not fallen because of the pain. As mentioned by Sandhu,
Heidenreich, Bhattacharya & Bundorf (2017), heart attack normally takes place when the
oxygenated blood flow to the heart reduces. It means that the SpO2 level of Mrs. Kennedy
has dropped due to the occurrence of a heart attack. This patient has undergone PTCA two
years ago. It means that she may have experienced a heart attack previously. History of CAD
of this patient has caused this heart attack.